Provider Demographics
NPI:1962959049
Name:CEJA, ANGELICA CLEMENCIA
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:CLEMENCIA
Last Name:CEJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7555 N DEL MAR AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6880
Mailing Address - Country:US
Mailing Address - Phone:559-554-8287
Mailing Address - Fax:
Practice Address - Street 1:7555 N DEL MAR AVE STE 206
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-6880
Practice Address - Country:US
Practice Address - Phone:559-554-8287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-06
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CA113465106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist